Transoral Approach and Extended Modifications for Lesions of the Ventral Foramen Magnum and Craniovertebral Junction
Transoral Approach and Extended Modifications for Lesions of the Ventral Foramen Magnum and Craniovertebral Junction
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DOI：
10.1055/s-2007-994288
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发表时间：
2007-11
期刊：
影响因子：
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通讯作者：
James Liu1 , 2;W. Couldwell1;Ronald Apfelbaum1
中科院分区：
文献类型：
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作者：
James Liu1 , 2;W. Couldwell1;Ronald Apfelbaum1
目的 描述我们进行经口入路以及枕骨大孔腹侧和颅椎交界处扩展入路的方法，并回顾技术方面和操作上的细微差别。设计审查。结果 经口入路提供直接中线暴露，以接近位于颅椎交界处和枕骨大孔腹侧的硬膜外病变。暴露走廊通常受到患者可以张开嘴的程度的限制。硬腭相对于颅椎交界处的位置限制了上部暴露，而下颌骨和舌根限制了下部暴露。大多数情况下，可以从下斜坡到中下C2椎体进行暴露。如有必要，可以进行扩展的经口入路以增加暴露。这些方法包括经上颌（Le Fort I 上颌切开术）、经上颌中线腭裂（扩展“开门”上颌切开术）、经腭和正中唇下颌舌切开术（经下颌裂）。结论 经口入路可以有效地直接进入颅椎交界处的硬膜外中线病变。专门的牵开器系统可以将下斜坡暴露给 C2 体。所描述的扩展方法可以接近超出这些限制的病变。
OBJECTIVES To describe our method of performing the transoral approach and the extended approaches to the ventral foramen magnum and craniovertebral junction and review the technical aspects and operative nuances. DESIGN Review. RESULTS The transoral approach provides direct midline exposure to access extradural disease located at the craniovertebral junction and ventral foramen magnum. The corridor of exposure is generally limited by the extent to which the patient can open his or her mouth. The location of the hard palate relative to the craniovertebral junction limits superior exposure, whereas the mandible and base of the tongue limit the inferior exposure. In most cases, exposure can be obtained from the inferior clivus to the middle to lower C2 vertebral body. Extended transoral approaches can be performed to increase exposure if necessary. These approaches include transmaxillary (Le Fort I maxillotomy), transmaxillary with a midline palatal split (extended "open-door" maxillotomy), transpalatal, and median labiomandibular glossotomy (transmandibular split). CONCLUSIONS The transoral approach effectively provides direct access to extradural midline lesions of the craniovertebral junction. A specialized retractor system can expose the inferior clivus to the C2 body. Extended approaches as described can access lesions that extend beyond these limits.